Vets: Laminitis can be treatable
When a favorite mount is diagnosed with laminitis, it isn’t necessarily a death sentence for the horse. According to two veterinary experts on laminitis, the disease is treatable, especially if it is caught in the earliest stages.
Bryan Fraley, DVM, is a equine foot specialist and farrier who operates Fraley Equine Podiatry in Lexington, Ky. Nora Grenager, VMD, is a practitioner at Harrison Clinic in Berryville, Va. and Woodside Equine Clinic in Ashland, Va. Both veterinarians addressed concerns about laminitis, or founder, during a recent webinar on TheHorse.com.
“Laminitis is an inflammation of the laminae,” said Grenager. “The laminae are velcro-like structures that hold the coffin bone inside the hoof.”
“They support the entire horse, so they need to be not only strong, but flexible, so the horse can walk and move appropriately,” she added. “There are a variety of things that can lead to laminitis, but the end result is those inflamed laminae can’t support the horse anymore, so they stretch and separate causing even more inflammation and pain for the horse. In severe cases, the coffin bone will pull away from the hoof wall, which we call rotation or sinking.”
Fraley added, “The most challenging part of laminitis is that by the time we see clinical signs like soreness, the horse shifting its weight or the hoof is hot, a lot of damage has already happened within the hoof. Our treatments at that point are in trying to treat the damage that has already been done. That is why we place so much focus on identifying risk factors of laminitis early to prevent the disease, rather than treating it.”
About 15 percent of horses suffer from laminitis, which has been known to cripple or kill them.
Insulin resistance is considered to be the top risk factor, Grenager said. Horses with equine metabolic syndrome are typically younger horses that are easy keepers and seem to survive on air and water, Grenager said. They will show fat pads on the crest of their neck, tailhead and behind the withers.
In older horses, equine metabolic syndrome is caused by Cushings. These horses will show similar fat deposits, a long, curly haircoat and failure to shed out.
Grenager said these horses are more likely to develop laminitis because insulin affects the hoof and how blood flows through it. Fortunately, tests are available to screen horses for insulin.
“I would also recommend including this test as part of a pre-purchase exam. It can successfully help identify horses that are at higher risk for laminitis,” she added.
Another risk factor is systemic illness like a retained placenta, bad case of pneumonia and diarrhea.
“Toxins and stress on the body can put them at high risk for laminitis,” Grenager said. “Also, if there is a severe injury in one limb and the horse starts putting more weight on the healthy limb to compensate, it can make them more susceptible.”
Allergies can also trigger the disease if the horse has a severe reaction, with swelling or hives.
Stages of laminitis
During the developmental stage of laminitis, the horse is not in pain, but the disease is developing through infection, carbohydrate or grain overload and causing damage to the laminae.
Next, the disease will progress to the acute stage where the owner will begin to notice the horse is in pain. The horse will have digital pulse, laminic stance and heat in the foot. At this point, a veterinarian needs to intervene to prevent the disease from progressing.
At the chronic stage, some displacement will have happened within the hoof capsule of the coffin bone – either rotation or sinking. Horses can be chronic stable or chronic unstable, which is dependent on if they have rotated and stopped and are remodeling their sole, versus actively rotating.
Both veterinarians said their goal is to stop progression of laminitis in the earliest stages so the horse can still have an athletic career.
“If we can prevent rotation or sinking at the acute stage, the horse has a chance to go on and become an athlete,” Fraley said. “It may have multiple acute episodes throughout its life, as long as it doesn’t displace. If it does rotate, sink or displace, it may still be able to have an athletic career, but it is less likely depending upon the extent.”
Laminitis can be a “forever-type” of condition, Fraley explained, depending upon the degree of laminitis, how long the horse has had it, and how it has been dealt with. Laminitis can be difficult to diagnose because it can mimic other diseases like chronic navicular disease.
“What I like to do is a physical exam, and try to narrow down the area of pain,” Fraley said. “I watch the horse travel and the gait of the horse. I also examine the hoof capsule, look for growth ring changes, and finally perform a thorough hoof tester exam. Sometimes, I have to resort to blocking.”
Although stem cell replacement may be a viable treatment option down the road, research is still being conducted to determine how to best use it.
In the meantime, horse owners can limit the affects of the disease through shoeing and trimming the feet of the horse.
“I like to move the weight of the horse from the outer hoof bearing wall axially, so the horse can bear weight more toward the center of the foot toward the frog, sole and bars,” Fraley said. “This works well, especially in horses that are sinking.”
“I have had horses with a penetrated sole and with very severe rotations, that years later it was difficult to tell they had any sign of laminitis, radiographically,” Fraley said. “With proper trimming and shoeing, we can have an amazing affect on how that horse remodels around the new position of the coffin bone.”
“However, that laminae attachment is never the same. There will be some type of scar tissue that will remain. You can increase the sole depth under coffin bone, but you can never reverse those changes completely in chronic cases,” he added.
Controlling the diet can also help with laminitis. Grenager said horses that are insulin-resistant may have problems consuming grass, which can contain non-structural carbohydrates (NSC). Fresh blooming grass, stressed grass from drought or a lot of rain, and overgrazed or mowed grasses can all be high in NSC and can be a serious risk to horses that are insulin-resistant.
Grenager said she recommends having the horse’s insulin resistance evaluated to see if they are resistant or sensitive and form a diet from there.
“There are different times of the day that are better to graze,” she said, “like first thing in the morning.”
While high risk horses may not be able to graze at all, others may need a grazing level or be drylotted.
“If a horse is locked up while its friends are out grazing, it is not helping its insulin level because it is stressed and unhappy, so some type of turnout is important,” she said.
Grenager said grass hay can also be soaked in hot water for 30 minutes or cold water for 60 minutes to help reduce the NSC level. It needs to be fed right away to prevent mold growth.
“Also, lowering the NSC reduces the vitamins and minerals in the hay, so make sure the horse is on a balanced vitamin and mineral supplement,” she said.
Lastly, both veterinarians shared research that has been done on icing the swollen, painful limbs. Ice has been proven to have anti-inflammatory affects and provide pain relief, Grenager said. The horse can be lead to a cold creek and allowed to stand in cold water. If a creek isn’t available, she recommends having the horse stand in icy slurry in feed pans up to its mid-cannon region.